Registered Nurse RN Clinical Reviewer
: Job Details :

Description

Introduction

Do you want to be appreciated daily? Our nurses are celebrated for being on the front line, empathetic for patients. At The Woman's Hospital of Texas our nurses set us apart from any other healthcare provider. We are seeking a(an) Registered Nurse RN Clinical Reviewer to join our healthcare family.

Benefits

The Woman's Hospital of Texas, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:

• Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation.
• Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more.
• Free counseling services and resources for emotional, physical and financial wellbeing
• 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service)
• Employee Stock Purchase Plan with 10% off HCA Healthcare stock
• Family support through fertility and family building benefits with Progyny and adoption assistance.
• Referral services for child, elder and pet care, home and auto repair, event planning and more
• Consumer discounts through Abenity and Consumer Discounts
• Retirement readiness, rollover assistance services and preferred banking partnerships
• Education assistance (tuition, student loan, certification support, dependent scholarships)
• Colleague recognition program
• Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence)
• Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income.

Learn more about Employee Benefits

Note: Eligibility for benefits may vary by location.

At The Woman's Hospital of Texas, our nurses play a vital part. We know that every nurse's path and purpose is unique. Do you want to create your own personal career path in nursing? HCA Healthcare is your career destination! Our scale makes it possible for nurses to create the career path that fits their life – for life – and empowers their passion for patient care. Apply today for our Registered Nurse RN Clinical Reviewer opportunity.

Job Summary and Qualifications

The Clinical Quality Improvement Specialist conducts a comprehensive current review of clinical documentation within the medical record to achieve, accurate and detailed documentation. Appropriate provider documentation for clinically indicated conditions or procedures, supports appropriate assignment of severity of illness, expected risk of mortality, intensity of service and resource consumption, which in return accurately, portrays the facilities, quality, outcome, ratings, reduces compliance risks, and captures appropriate reimbursement.

What you will do in this role:

• Reviews medical records and identify potential gaps in clinical documentation for specified facilities, patient types and payer populations, as directed on admission and throughout the hospitalization.
• Performs initial concurrent review of assigned population, consistent with facility, division, or corporate program volume and frequency requirements.
• Performs follow up reviews consistent with facility, division or corporate program volume frequency requirements.
• Ensure the appropriate documentation of the principal diagnosis, complications or co-morbid conditions, and or valid OR procedures, including the capture of POA indicators.
• Ensures, documented conditions, clarifications, and coded diagnosis are clinically supported.
• Documents reviews, and other pertinent information in designated systems by established deadlines.
• Uses clinical judgment to determine when and or if additional documentation is necessary.
• Performs the medical record review for conflicting, imprecise, incomplete, illegible, or inconsistent documentation by requesting and obtaining additional documentation within the health record when appropriate.
• Interacts with physicians to complete/resolve queries prior to patient's discharge.

What qualifications you will need:

• Current RN license required with Critical Care, OR, ER experience preferred
• 5-7 years relevant work experience
• Preferred experience in Case Management, HIM/coding, related experience in Acute Inpatient setting

At The Woman's Hospital of Texas, our care philosophy is Woman First. It's in our name, and it's in our founding mission. Our 420+ bed hospital was founded in 1976 by 29 physicians who recognized a need in Houston for a facility focused solely on women in all stages of life. We were the first women's hospital in Houston and first facility in Texas dedicated to the health of women and newborns. Today, we are the state's premier facility dedicated to the health of women and children offering expertise and an outstanding level of care in breast health, imaging, gynecology, minimally invasive surgery, infertility, obstetrics, high-risk pregnancy, and pediatrics. We deliver 800+ babies a month, more than any other hospital in Texas, and care for more multiple births than any other hospital in the region. Our Level IV NICU provides the highest level of care for premature babies and we have the area's only March of Dimes NICU Family Support program. As a member of HCA Houston Healthcare, the most comprehensive healthcare provider in the region, we are a part of a network that delivers stronger, smarter and more accessible care to women than any other medical system across the Houston area.

HCA Healthcare has been recognized as one of the World's Most Ethical Companies® by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.

The great hospitals will always put the patient and the patient's family first, and the really great institutions will provide care with warmth, compassion, and dignity for the individual. - Dr. Thomas Frist, Sr.HCA Healthcare Co-Founder

Join a family that cares about every stage in your career! We are interviewing candidates for our Registered Nurse RN Clinical Reviewer opening. Apply today and a member of our Talent Acquisition team will reach out.

We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.